Differential Diagnosis for a 2-year-old boy with seizure, abdominal pain, and bloody diarrhea
- Single most likely diagnosis:
- Shigella gastroenteritis: This is the most likely diagnosis given the patient's symptoms of abdominal pain, fever, watery diarrhea that progressed to bloody diarrhea, and seizure. Shigella infections can cause seizures, especially in young children, due to the toxin produced by the bacteria.
- Other Likely diagnoses:
- Salmonella gastroenteritis: Similar to Shigella, Salmonella can cause gastroenteritis with symptoms of abdominal pain, fever, diarrhea (sometimes bloody), and can lead to seizures in severe cases.
- Escherichia coli (E. coli) infection: Certain strains of E. coli, like E. coli O157:H7, can cause severe gastroenteritis with bloody diarrhea and potentially lead to neurological complications, including seizures.
- Rotavirus gastroenteritis: Although less likely to cause bloody diarrhea, rotavirus can lead to severe dehydration and electrolyte imbalances, which might precipitate a seizure.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Meningitis: Although the patient's symptoms do not strongly suggest meningitis (e.g., no mention of neck stiffness, headache, or altered mental status), it is crucial to consider and rule out meningitis, especially in a febrile child with a seizure, due to its high morbidity and mortality if untreated.
- Intussusception: This condition, where a part of the intestine telescopes into another, can cause abdominal pain, bloody stools, and potentially lead to seizures if the child becomes severely dehydrated or if there is significant bowel ischemia.
- Hemolytic-uremic syndrome (HUS): This complication, often associated with E. coli O157:H7 infections, can lead to renal failure, anemia, and neurological symptoms, including seizures.
- Rare diagnoses:
- Neuroinvasive enterovirus infection: Certain enteroviruses can cause neurological manifestations, including seizures, but this would be less likely given the gastrointestinal symptoms.
- Cystic fibrosis with meconium ileus: Although not directly related to the seizure, this condition could explain the abdominal symptoms, but it would be unusual for it to present for the first time with such severe symptoms at the age of 2.